By Mary Otto
The prevalence of multigenerational grandfamilies in America is impacting the oral health of both grandparents and the children they are raising, according to the findings of a recent survey conducted on behalf of Oral Health America.
Nearly three-quarters of grandparents reported that they faced challenges in trying to obtain oral health care for their grandchildren, and 57 percent said they delayed their dental care to accommodate the cost of their grandchildren’s oral care.
There were wider health impacts as well, with the survey finding that 78 percent of grandparents said they had experienced fatigue, sleep problems, depression and anxiety since taking on the care of their grandchildren. There were benefits too, according to the findings. More than half the grandparents surveyed said they were more likely to eat healthier foods because they were caring for grandchildren.
There are probably grandfamilies in your community who would be willing to speak about the multigenerational challenges and rewards they have encountered in finding care and staying healthy.
As you report on the effort to add a dental benefit to Medicare, here are some things to keep in mind:
Life Without Dental Benefits
Most Americans with private dental benefits tend to lose them when they retire. The National Association of Dental Plans estimates that more than 46 million Americans over 65 are dentally uninsured.
Nearly half of seniors (49 percent) cited the cost of care as the reason they had not visited a dentist in the past year, according to an analysis by the American Dental Association.
Very-low income elders may qualify for Medicaid, but in regards to dental care the program is not always very helpful. Medicaid dental benefits for poor adults vary from state to state, and care can be hard to find. Lack of care takes a toll.
Federal research indicates that 18 percent of Americans 65 years or older have untreated decay, with black, Hispanic and lower-income elders suffering from elevated rates of untreated decay.
Untreated disease has costly consequences, not only for individuals but the health care system as a whole. It leads to pain, tooth loss, poor nutrition, social isolation, expensive emergency room visits and hospital admissions.
“In a way, older people are victims of dentistry’s success,” Michelle Andrews reported in a recent piece on the oral health needs of seniors for National Public Radio. “Regular visits to the dentist, along with daily tooth brushing and water fluoridation, have all contributed to improvements in oral health.”
In Andrews’ story, Dr. Michael Helgeson, chief executive officer of Apple Tree Dental, a Minneapolis-based nonprofit organization that provides care to underserved seniors, noted that in the first half of the 20th century, by the time people reached their 30s or 40s many had already lost all their teeth.
Today more than 60 percent of people in nursing homes still have at least one tooth, Helgeson said.
A Little History
Since the program began in 1965, Medicare has not included coverage for routine dental services.
As former Los Angeles Times reporter and “Help with Aging” blogger Bob Rosenblatt explained in a column, Medicare also tends to stop short of covering items such as hearing aids and eyeglasses.
“Medicare is an acute care system, focusing on treating people and curing their diseases, not taking care of all the routine things that come with age,” he wrote.
The idea of adding routine hearing, vision and dental benefits to the program has been raised from time to time. U.S. Rep Jim McDermott, a Washington state Democrat, last year championed a bill that would amend Medicare Part B to include benefits for routine and major dental care, refractive eye exams, hearing exams and hearing aids. McDermott did not identify a funding source and acknowledged costs would be a barrier to its passage in the Republican-controlled House of Representatives.
Link Between Oral Health and Systemic Disease
It often has been observed that oral health is integral to overall health.
Elders who suffer from untreated oral disease face a greater risk for pain and tooth loss, which in turn negatively affect nutrition and social functions. Also, dangerous oral cancers may go undetected.
Advocates who are building a new case for adding a dental benefit to Medicare point to evidence that providing timely oral health care may help reduce costs for chronic disease management and hospitalizations. And an ongoing dental and medical cost study by insurer CIGNA supports a potential adverse association between untreated gum disease and higher medical costs for diabetes, cardiovascular disease and stroke.
The paper estimates that periodontal treatments can lower the cost of caring for a patient with diabetes, cardiovascular disease and stroke from between $647 and $10,142 in a year.
Another study, funded by United Concordia Dental and published in the American Journal of Preventive Medicine also concludes that the treatment of periodontal disease may improve health outcomes for patients with other conditions such as type 2 diabetes.
But some critics, including the author of this paper, have questioned the reliability of such research so far and stress that more study is needed to understand the impact of oral care on systemic diseases and conditions.
A Local Angle
Finally, how are the seniors in your community doing regarding oral health? For a few selective measures, you might want to look at Oral Health America’s latest State of Decay report, which finds the oral health of elders varies widely by state.
